Bactrim for 10 Years for Severe Cystic Acne, Accutane Now?

Question

I've been on Bactrim DS for 10 years for large cysts on my face(1-2 a year, sometimes 2" in size). I recently tried going off of the Bactrim now that I'm older, and had a severe breakout(50+ cysts on back in 3 weeks), on back, shoulders, knees/upperlegs, face and chest. Bactrim slowly cleared me up again. Should I be going on accutane or staying on bactrim forever? I'm worried at this point accutane might not be effective(severity) or last and long-term bactrim may have worsened the problem.

Raffy Karamanoukian, MD, FACS · Answer

Accutane is a go-to medication for patients with recalcitrant cystic acne. It can reduce pore size and also reduce sebum production in your skin, making it less oily; and in turn, dryer. Accutane can be used to control acne, but patients receiving the medication should be carefully monitored. In terms of skincare, always wear an appropriate sunscreen and reduce direct sun exposure. In my patients, I recommend a good ceramide moisturizer such as Elevase whenever they are on Accutane. This will keep the skin hydrated and reduce the oiliness of the skin that is associated with oil-based moisturizers.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Tobi B. Richman-Steinhardt, MD · Answer

Men who have long-term cystic acne on the back have a very good chance of improving with a 5-month course of Accutane. Although you have been on Bactrim for an incredibly long time (!), I would not expect that it has worsened the problem for you---you've just suffered a delay in getting to the more effective therapy! Accutane works in a completely different way than antibiotics do, so it's a good choice for you to consider with proper screening by your dermatologist.

Dornechia George Carter, MD · Answer

I think Accutane would be a viable next step for you. Ten years is a long time to be on Bactrim, and it sounds like discontinuing the medication is not an option for you. Many--most--patients have a long term remission after completing and approriate course of Accutane, although a few may need to repeat courses.

T. Wayne Day, MD · Answer

Ten years is a long time to be on Bactrim. Doxycycline is a safer long term acne antibiotic so I am surprised that hasn't been your maintenance medication.

	You are right to consider Accutane. It is an ideal option for stubborn or severe acne. You will need to be on it for approximately five months with monthly visits to monitor your blood tests. There is an 80% chance that you will be essentially cured. If it doesn't cure your acne, after a rest period of several months, you should consider a second five month treatment.

	The most common side effects are dry lips and dry skin. Other things like depression and intestinal problems get a lot of press but actually are uncommon and can be watched for by your dermatologist.

F. Victor Rueckl, MD (in memoriam) · Answer

Accutane works well for body and facial acne, so there's no reason not to try it. I prescribe it to many patients for severe cystic acne, many of whom have tried and used other topical or oral medications before. Based on the photo and your description, Accutane seems like a good solution for you.

Bactrim for 10 Years for Severe Cystic Acne, Accutane Now?

Answers (5)